ISSA Chapter 7: Client Assessments

Chapter Goals:

• Be able to explain the purpose and importance of fitness assessments for fitness professionals.
• Know the most common subjective assessments that personal trainers use to gather information.
• Be able to discuss static and dynamic posture and give examples.
• Know the most common assessments of body composition.
• List and describe the common cardiovascular assessments used in fitness.
• Know the common muscular strength and endurance assessments and their purpose as fitness assessments.

Subjective Assessments

These fitness assessments require observation or some opinion-based measure.

Forms collected by fitness professionals from their clients will need to be collected carefully and stored in a secure location to ensure their privacy is secured.

Personal training is not technically considered to be in health care, so HIPAA is not as closely watched. But, trainers should abide by the rules set by these guidelines.

The first form a client should fill out is the initial interview packet. This includes items like:

• Client Intake Form
• PAR-Q
• Health History Questionnaire
• Liability Waiver
• Physician’s Letter of Clearance
• Three-day Dietary Record

Client Intake Form

This foundational form aims to gather demographic info like the client’s address, phone number, and email.

Some other questions would be, ” Has your doctor diagnosed you with the (blank) condition?” and such questions.

It is a good idea to include questions regarding your client’s health and fitness goals.

Introducing this form in introductory sessions or upon meeting the client is typical.

This introduction stage with the client really builds rapport with the clientele.

Physical Activity Readiness Questionnaire

The PAR-Q is an extension of a client’s medical history and is completed by the client after committing to a program and before actually starting the said program.

The PAR-Q is a collection of yes and no questions that lead to medical answers. When answered yes, it will likely require clearance from a doctor.

Health History Questionnaire

This detailed client intake form gathers past and present health and medical history information.

It has questions regarding exercise experience, tobacco use, and nutrition.

Liability Waiver

This short form releases a fitness professional and their training facility from liability should the client become injured while working out.

All programs carry some inherent risk for injury, so by signing this form, the client accepts any and all risks from training.

This type of form is an industry-standard.

Physician’s Letter of Clearance

When someone has an injury or some form of ailment or even answers yes on the PAR-Q, they will often need this clearance letter from a medical professional.

This signed letter of clearance from a health care provider states that the person is cleared for activity and exercise and if they have restrictions and limitations.

Three-Day Dietary Record

This is a very common fitness and nutrition intake form that allows clients to log their food consumption for three days in a row.

This provides a pretty accurate look into the nutrition of your clients.

You should follow this up with general questions that look to clarify points.

This intake form and the initial client interview will be the client profile. The client profile collects health and intake forms, biometric measures, training plans, and liability waivers.

Aboslute Contraindications

These are some of the issues which personal trainers should accept:

• Unstable coronary heart disease
• Decompensated heart failure
• Uncontrolled heart arrhythmias
• Severe pulmonary hypertension
• Severe and symptomatic aortic stenosis
• Acute myocarditis, endocarditis, or pericarditis
• Uncontrolled hypertension
• Aortic dissection
• Marfan syndrome
• Active proliferative retinopathy

Relative Contraindications

Client’s with these issues can begin a program once they have consulted with their medical professional and trainers have received written consent or guidelines to follow.

• Risk factors for CHD
• Diabetes
• Low functional capacity
• Musculoskeletal limitations
• Pacemaker or defibrillator

Objective Assessments

These assessments are designed for the collection of measurable data. They will have one distinct answer and aren’t subject to opinion or observer variance.

These assessments will provide information for programming, motivation, and client success.

For object assessments, some considerations to be had would be things like:

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• When you weigh clients, try to do it simultaneously each day.
• Take the caliper and circumference measures on the same side of the body every time you do them.
• Use the same equipment to take these measures, as equipment may vary in the slightest.

Body Composition Assessments

Body composition is the body’s physical makeup, considering the fat and lean mass.

This is important to track for many clients, as they wish to see results from their programs.

Lean body mass is the mass that is free of fat and calculated by total weight minus body fat weight.

Body fat norms will differ significantly based on sex.

For men, the body fat percentage categories are:

• Low/Essential = 4 – 6 percent
• Athletic = 7 – 10 percent
• Fit = 11 – 16 percent
• Average = 17 – 25 percent
• High/Overweight = 26 or higher percent

For women, the body fat percentage categories are:

• Low/Essential = 10 – 12 percent
• Athletic = 13 – 20 percent
• Fit = 21 – 24 percent
• Average = 25 – 31 percent
• High/Overweight = 32 or higher percent

Body Mass Index

Also shortened to BMI, this is a measure for predicting disease risk but may not be suitable for more fit clients, as it does not consider lean body mass.

BMI is found by dividing weight in kg by height in meters squared.

The ranges for BMI are:

• Underweight = below 18.5
• Normal weight = 18.5 – 24.9
• Overweight = 25 – 29.9
• Obese is 30 or higher

Waist-to-Height Ratio

This assessment is used to measure cardiometabolic risk.

The waist-to-height ratio is measured by waist circumference divided by height and then multiplied by 100.

Girth Measurements

These may also be known as circumference measurements, and they are measurements of size around key areas like the hips, thigh, neck, and chest, with potential for any location on the body.

It is recommended to take these measures on the same side of the body every time to get the most accurate measures.

Skinfold Measurements

Skinfold measures are valuable for approximating body density and body comp without being too invasive or intimidating.

Body density is the compactness of the body determined by dividing mass by volume.

Measurements should still be taken on the same side of the body.

The sites of girth measurements are where the most subcutaneous fat is held, which is measured with skinfold calipers.

The measurement sites are:

• Triceps: the arm stays relaxed and to the side; a vertical fold is measured halfway between the shoulder and elbow.
• Subscapular: the middle of the scapula is found, and a vertical fold is measured one inch from the spine.
• Chest: measure one inch under the collarbone and 2 – 3 inches from the edge of the pec muscle.
• Midaxillary: measure the fold horizontally at the point where a vertical line from the mid axilla intersects the horizontal line level with the sternum. The skinfold is pulled vertically.
• Suprailliac: measure halfway between the navel and the top of the hip. Pull the skinfold in a vertical direction.
• Abdominal: measure one inch to the left of and one inch down from the navel. Pull the skinfold vertically.
• Thigh: Measure in the middle of the quads. If too tight, go up 1 – 2 inches. Pull the skinfold vertically.

The seven site exam involves all the above sites. The three-site exam involves the chest, abdomen, and thigh for men. For women, the three-site test involves the triceps, suprailliac, and thigh sites.

Bioelectrical Impedance

This is a method for body composition assessment using weak electrical currents to measure resistance of the tissues.

These machines send an electrical current from one point to another and measure the time it takes to travel between the two points.

This is based on muscle containing more water than fat cells.

Air Displacement Plethysmography

This is a safe and accurate way to measure fat mass and fat-free mass in both adults and children.

This test is expensive and requires the ADP chamber and staff specialized in using it.

Hydrostatic Weighing

This is a tool to measure body comp using water displacement and tissue density.

This requires a lot of steps, but it is an accurate way to measure body composition.

Dual Energy X-Ray Absorptiometry

This is the gold standard body comp method and that is because it is the most accurate test.

This determines the amount of bone, fat tissue, organ tissue, and muscle mass in the body.

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It can also be good for detecting osteoporosis since it scans bone.

Cardiorespiratory Assessments

A client’s cardiorespiratory fitness level is determined by how well their muscles, heart, and lungs all work during different degrees of activity intensity.

Objective data that is relevant here will be the heart rate and blood pressure.

Subjective data will be client reports of exertion and difficulty breathing.

Resting heart rate is a measure of heart rate when completely at rest.

On average, this value will be between 60 and 100 beats per minute. Well-trained individuals can be even lower than 60.

Some things that affect the resting heart rate of an individual will be high temps, emotions, medications, stimulants, recent exercise, and standing up.

Blood pressure is not a measurement typically taken by personal trainers, and instead they usually look at measures from other medical professionals.

But, it is entirely possible and easy to measure.

Blood pressure categories:

• Normal = less than 12/80 mm Hg
• Elevated = a systolic of 120 – 129 and diastolic less than 80 mm Hg
• Stage 1 hypertension = systolic of 130 – 139 or diastolic of 80 – 89
• Stage 2 hypertension = systolic at least 140 or diastolic at least 90 mm Hg

In general, the purpose for cardio assessment is to find the measure of a client’s VO2 max.

The VO2 max is the max amount of oxygen someone can use during exercise.

Track Tests

These tests are named as they are done on a track typically, but some may be acceptable on a treadmill.

Running is not always ok for clients, so walking tests can be utilized in these cases.

Cooper 12 minute run is suitable for most people. The total distance covered in 12 minutes is recorded as the value for this. Then the recorded value is plugged into the formula.

The 1.5 mile run has the time recorded when 1.5 miles is completed. The norms are not adjusted for age, so it may not be suited for all clients.

The Brockport one mile walk has weight measured prior to doing it, and then the client completes one mile as quickly as they can. Pulse is recorded for one minute after.

Step testing is a good form of testing for conditioned clients. The step is 12 inches higher and you need a stopwatch and metronome to keep the proper pace.

Muscular Strength and Muscular Endurance Assessments

These test can be rather useful prior to designing the programs fully, as it gives some reference weight to use for exercises.

These assessments require good amounts of warm up prior to doing. Both general and specific warm ups are ideal.

One rep max is a single maximum strength repetition with max load possible.

muscular endurance tests look at the ability for muscle groups to overcome resistance in as many reps as possible.

Bench Press Test

Most clients should not do a true one rep max test, and instead should do an estimated max test. This is estimated by doing the max weight at a higher number of reps.

Push-up Test

When doing a push up test, the client will do as many reps with good form as they can in a one minute time frame.

This can be done as a modified push up from the knees, but make sure to note this in the client’s profile.

Lower Body Strength Test

This can be done with a one rep max test or an estimated one rep max test. The exercise can be a squat or a seated leg press.

Make sure to not do this with clients that have a history of knee problems and other related injuries.

Movement and Posture Assessments

These assessments allow for determining muscular weaknesses or muscular imbalances a client may have that can be effectively addressed in an exercise program.

A muscular imbalance is when the muscle or muscles on one side of the body are stronger, weaker, or more or less active than the muscle on the other side of the body.

Kinetic Chain

The kinetic chain is a system of links, or joints, that generate and transfer force from one to another.

The checkpoints of the human body’s kinetic chain are:

1. Foot and ankle
2. Knee
3. Hips
4. Spine
5. Shoulders
6. Head and neck

Overactive muscles are shortened beyond the optimal length and have high neural activation. They are tight feeling.

Underactive muscles are lengthened beyond their optimal length and are inhibited and less capable of producing force

Every kinetic checkpoint has a group of muscles that work together to generate various movements. these are called muscle synergies.

A muscular force couple is when two or more muscles generate force in different linear directions at the same time to produce one movement.

A closed kinetic chain movement is a movement keeping the distal end of the body segment in action fixed.

An open kinetic chain movement is a movement with the distal aspect of the body segment being free.

Posture and Movement Assessments

Static posture is the posture when standing upright and still.

Movement assessments are observations and critiques of movement patterns or exercise form.

Posture and movement assessments should be done occasionally throughout an exercise program. The frequency is dependent on the timeline of the program.

Ideal posture is when the feet, knees, and hips are level and even, pointing straight ahead. The spine has a normal S curve, and the head/neck are neutral. Arms hang naturally and even to the sides.

Most people have some amount of deviation to this ideal posture.

Spinal deviations can be observed in assessments and observations.

Lordosis is the excessive inward curve of the lumbar spine.

Kyphosis is an excessive curve of the spine, but it is found in the upper spinal region.

Flat-back is an excessive lumbar flexion and posterior pelvic tilt.

Swayback is a posterior tilt with an excessive extension of the lumbar spine that protrudes the butt.

Scoliosis is a sideways curvature of the spine.

Handedness is the tendency to use one side more than the other. This leads to minor dysfunctions.

Knee valgus is when the position of the knee is near the midline of the body.

Knee carus is when the position of the knee is away from the midline of the body.

The squat assessment is a functional subjective assessment that is good for all ages of clients.

This movement assessment views the body during a squat with the goal being to identify movement dysfunction in the kinetic chain.

The overhead squat is similar and it has the arms above the head and can find even more movement dysfunctions.